Provider Demographics
NPI:1053666404
Name:BALZANO, BOBIE-JO (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BOBIE-JO
Middle Name:
Last Name:BALZANO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 KID LONG RD
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-8507
Mailing Address - Country:US
Mailing Address - Phone:814-937-3287
Mailing Address - Fax:
Practice Address - Street 1:113 SUMNER ST STE 3
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-2118
Practice Address - Country:US
Practice Address - Phone:814-937-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0195291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical